Action Points

Note that this cluster-randomized trial found that an intervention focused on increasing social interactions in the elderly with dementia had beneficial effects on quality of life.

The intervention also led to cost reductions compared with usual care.

Social-based care in nursing homes greatly improved the quality of life of those with dementia, researchers reported.

Compared with having usual care, those receiving WHELD (well-being and health for people with dementia) care showed a significant improvement in quality-of-life scores (mean difference 2.54, 95% CI 0.81-4.28, Cohen's D effect size 0.24), found Clive Ballard, MD, of Exeter University in the U.K., and colleagues.

In an email to MedPage Today, Ballard explained that the group "wanted to develop evidence-based effective training that was practical and could be implemented widely," adding that there is both "variable and often poor standard of care for people with dementia" as well as "very little evidence-based training for staff [of care homes]."

People with dementia living in care homes often have extremely low levels of activity and social interaction, he noted, with a previous study by his team suggesting that these individuals may receive on average of only 2 minutes of social interaction over 6 waking hours.

No other interventions have demonstrated a robust benefit on quality of life -- that was the aim of augmenting the person-centered care training with specific person-centered activities -- but it was great that this additional element translated into quality-of-life benefit," Ballard said.

The randomized controlled cluster trial recruited 847 people with dementia from 69 various nursing homes in the U.K. The 9-month study assigned individuals to receive either treatment as usual or the WHELD intervention. Groups were generally similar at baseline, with the majority of patients having moderately severe dementia or severe dementia.

The WHELD intervention included a 1-month training period, delivered by a research therapist, for care home managers, staff, and residents. Some of the aims of the intervention included implementing person-centered care, establishing structured social activities for around 1 hour per person each week, understanding individualized needs of patients, and comprehending antipsychotic practice guidelines.

Although relatively low to begin with (<10% for both groups), use of antipsychotic medications remained generally stable throughout the trial, with no major difference in cessation between groups (antipsychotic use at 9 months: WHELD versus treatment as usual relative risk 1.06, 95% CI 0.62-1.82, P=0.82). The researchers noted this low use of medications at baseline likely reflects "the major changes in clinical practice and the reductions in antipsychotic use that have been achieved for people with dementia in the last decade."

In a subgroup analysis, quality of life, agitation, and neuropsychiatric symptom improvements from the intervention were most notable among those with moderately severe dementia. Those with mild to moderate dementia or those with severe dementia did not see a significant change in quality of life.

Serious adverse events were generally equal between the two treatment groups, with the most common event being mortality (RR 1.08, 95% CI 0.8 -1.35, P=0.50).

A cost analysis also showed that the WHELD intervention was actually less costly than usual care -- saving roughly $6,600 (£4,740) -- over the 9-month trial: "We designed the intervention to be cost-effective -- but it was great that the overall costs were less than usual care," Ballard noted.

He said that regarding future research, he and his colleagues would like to look at ways to sustain the benefits for the longer term: "We've been developing ways of trying to make that more cost-effective with blended-learning approaches using more e-learning and Skype supervision in combination with in-person support."

The study was funded by the U.K. National Institute of Health Research, Programme Grant for Applied Research.

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